Too few platelets? The difference between thrombocytopenia and hemophilia
Thrombocytopenia and hemophilia are both clotting disorders, but differ in cause, symptoms and treatment. With targeted blood tests, you can diagnose a platelet or clotting factor deficiency quickly and reliably.
Rapid bruising, nosebleeds or small pinpoint bleeds in the skin: these can be signs of a clotting disorder. Many people immediately think of hemophilia, but did you know that thrombocytopenia is at least as common - and has a very different cause?
In this blog, we explain the difference between these two conditions, discuss the possible causes of a lowered platelet count, and provide tips for appropriate blood tests.
What is thrombocytopenia?
Thrombocytopenia literally means a deficiency of platelets (thrombocytes). Platelets are essential for the first step in blood clotting. They ensure that a wound is closed quickly. If you have too few platelets, you can bleed more easily - even spontaneously.
Common complaints in thrombocytopenia
- Rapid bruising (purpura)
- Small red or purple dots on the skin (petechiae)
- Nosebleeds or bleeding gums
- Prolonged menstruation or subsequent bleeding
- In severe cases: internal bleeding
Causes of thrombocytopenia
An insufficient platelet count can have several causes. These can be broadly divided into three categories:
- Reduced production in the bone marrow
The bone marrow does not make enough platelets due to:
- Bone marrow disorders such as leukemia, myelodysplasia or aplastic anemia
- Viral infections such as hepatitis, HIV or Epstein-Barr virus (EBV)
- Exposure to toxic substances such as alcohol, chemotherapy or radiation
- Deficiency of vitamin B12 or folic acid
- Increased breakdown or consumption of platelets
The body breaks down platelets faster than normal:
- Autoimmune diseases such as ITP (immune thrombocytopenia)
- Certain medications (such as heparin or some antibiotics)
- Infections such as sepsis, dengue or COVID-19
- Systemic diseases such as lupus (SLE)
- Rare disorders such as TTP or HUS
- Sequestration in the spleen (storage)
An enlarged spleen can "hold" platelets:
- Cirrhosis of the liver
- Certain blood diseases
- Chronic infections
Sometimes a mild platelet deficiency is temporary, such as after a viral infection. It can also be hereditary without obvious symptoms. The severity of symptoms depends on how low the platelet count is and whether there are other abnormalities, such as clotting problems.
What is hemophilia?
Hemophilia is an inherited clotting disorder in which a specific clotting factor is missing - usually factor VIII (hemophilia A) or factor IX (hemophilia B). As a result, the second step of blood clotting does not work properly, and deep bleeding occurs especially in muscles and joints.
Complaints in hemophilia
- Spontaneous joint or muscle bleeding (hemarthrosis)
- Prolonged bleeding after cuts, surgeries or dental treatments
- Large bruises after light bumps
- Less frequent minor skin bleeding
Summary: the differences between thrombocytopenia and hemophilia
Feature | Thrombocytopenia | Hemophilia |
What is missing? | Platelets | Coagulation factor VIII or IX |
Cause | Mostly acquired | Hereditary (X-linked) |
Occurs in | Women and men | Especially men |
Bleeding pattern | Minor skin bleeding, nose bleeding | Deep muscle or joint bleeding |
Heredity | Rarely | Yes |
Treatment | Depending on cause | Replenishing coagulation factor |
What blood tests are relevant?
If a coagulation disorder is suspected, blood tests are the first step. You can quickly and easily request this yourself via Bloedwaardentest.nl.
- Platelets and complete blood count
Measure the number of platelets, red and white blood cells.
- Coagulation testing including factor VIII/IX
Comprehensive examination of clotting time and clotting factors.
- Vitamin B12, folic acid and liver function
Deficiencies or liver problems can affect platelet production.
